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Title: Chronic malnutrition in rural Zimbabwe
Author: Mucavele, Patricia Jane
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2003
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Chronic energy malnutrition remains the major silent global nutritional challenge for the future. This thesis investigates specific factors which may have contributed to its unabated persistence. A critique of the literature concludes that nomenclature, the complexity and unspecific nature of multi-factorial chronic malnutrition problems, narrowness of medical physiological based conceptual models to identify the origins of nutritional risk, and the technical difficulties associated with the accurate assessment and monitoring of nutrition status amongst the free-living have contributed to the limited progress in abating chronic energy malnutrition. To illustrate the dimensions of the above problem the prevalence, severity, seasonality and determinants of chronic energy malnutrition within and between subsistent agricultural households residing in a drought prone, food deficit area of Zimbabwe are investigated. A comprehensive longitudinal food, health and anthropometric survey of 354 households was conducted over a 15 month period and has been analysed. To capture both the seasonal dynamics of the nutrition situation and intra-household nutritional status, all household members were measured. Anthropometric indices were used as proxies of child and adult nutritional status. To identify the main risks and determinants of nutrition security a set of simple indicators used as proxies for dietary intake, health status, care and household welfare were estimated and equated with anthropometric status. Simultaneous analysis of adult and child anthropometry unveiled a paradoxical situation with the co-existence of high prevalence of chronic under-nourishment amongst children with high rates of adult female over-nourishment. Over a third of the children were diagnosed as stunted, (height for age < -2SD) and quarter were estimated to be underweight (weight for age < -2SD). Concurrently, over a fifth of the adult female population were classified as overweight (BMI 25-29.99) a further 10% depending on the season were diagnosed as obese (BMI > 30). Contrarily, a quarter of the male population were diagnosed as chronic energy deficient CED (BMI < 18.5). Male over-nourishment was virtually non-existent. Combining the above results with low rates of child wasting < 10%, the Buhera population is diagnosed as severely chronically malnourished. The study attributes the intra and inter household differences in nutritional status to physiological, diet, infection, socio-economic, cultural and environmental factors. The seasonal variation in nutritional status was uncharacteristic. Optimal adult nutritional status was observed in March at the end of the pre-harvest period. Modest seasonal oscillations in adult body weight equivalent to an absolute change of 4-5% were observed. Seasonal fluctuations in child growth rates were detected, a lagged association was found between significant pre-harvest weight gains and the following post-harvest rate of height velocity. Self-reported illness was associated with seasonal weight loss. The existence of both extremes of the chronic energy malnutrition spectrum within and between households suggests considerable heterogeneity in biological response to prevailing food insecure and poor environmental conditions in Buhera. The low ratio of CED:obesity observed amongst women provides evidence that over-nourishment previously associated with affluent societies is becoming the burden of the rural poor. These two findings present a dual challenge when developing policies and programmes to alleviate chronic malnutrition.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available